Cognitive Improvements in Sinking Skin Flap Syndrome Using a Negative Pressure Helmet

Sinking skin flap syndrome, also known as syndrome of the trephined, is a rare but serious complication that can occur following a decompressive craniectomy. It is characterized by neurological deficits that worsen with atmospheric pressure changes affecting the brain. Long-term treatment typically involves cranioplasty; however, temporizing measures are often needed when cranioplasty cannot be performed immediately. This case report introduces a minimally invasive approach using a negative-pressure helmet as a temporary therapeutic device aimed at prolonging survivability and restoring cognitive function in a patient with sinking skin flap syndrome. In this case, the patient presented as a 71-year-old male with a prior craniotomy bone flap that became infected, requiring craniectomy, and developed aggressive syndrome of trephined shortly after surgery. A replacement skull flap was not readily available, and due to infection, placing foreign hardware was suboptimal, but the patient was experiencing significant and worsening mass effect, which warranted urgent intervention. This case demonstrates the life-saving effects of using a negative pressure helmet as an emergency measure to relieve midline shift caused by sinking skin flap syndrome. This method, while novel, may serve to be integrated as a widely used treatment for certain patients with sinking skin flap syndrome.